Technical feasibility and safety profile of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT)

Abstract

Background: In this study, we specifically aimed to analyze the technical and safety aspects of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) in patients with type 2 diabetes (T2DM). Methods: A total of 360 patients with type 2 diabetes who underwent a DSIT procedure within the past 2-year period (2011–2013) were analyzed. Operation time, length of hospital stay, perioperative and postoperative complications, and mortality were recorded and analyzed. Results: The participants consisted of 229 males (63.6 %) and 131 females (36.4 %). Mean duration of follow-up was 12.4 months (range, 6–31). One early and two late mortalities occurred. Early mortality was due to an anastomotic leak, and late mortalities were related to myocardial infarction and a traffic accident. Leakage and bleeding were the most common surgical complications. The total number of surgical complications was 22 (6.1 %). Of those, 19 occurred within the first month (early) and 3 occurred after the first month (late). Among early complications, seven (1.94 %) required re-operation, two patients (0.55 %) required endoscopic treatment, and the remaining ten were managed conservatively. Late surgical complications (sleeve angulation) were noted in three patients (0.83) and were treated by endoscopic stents. Surgery-related non-surgical complications occurred in 19 cases (5.2 %), and neurological complications were noted in 11 patients (3.05 %). Additional surgical intervention was required in 26 patients (7.22 %). Of those, 15 (4.16 %) required cholecystectomy. Conclusions: Our data demonstrate that DSIT is a technically feasible operation and can be safely performed in type 2 diabetic patients with acceptable complication and mortality rates.